Brazilian Dental Journal (2017) 28(4): 467-473 ISSN 0103-6440

http://dx.doi.org/10.1590/0103-6440201601531

Marginal and Internal Adaptation

1Graduate Program in Dentistry, UP -
Universidade Positivo, Curitiba, Brazil
2Department of Operative Dentistry,

of Zirconia Crowns: A Comparative University of North Carolina School

of Dentistry, Chapel Hill, NC, USA
Study of Assessment Methods
Correspondence: Carla Castiglia
Gonzaga, Rua Prof. Pedro Viriato
Parigot de Souza, 5300, 81280-
330 Curitiba, PR, Brasil. Tel:
+55-41-3317-3180. e-mail:
Rafael Schlögel Cunali1, Rafaella Caramori Saab1, Gisele Maria Correr1, carlacgonzaga2@gmail.com
Leonardo Fernandes da Cunha 1, Bárbara Pick Ornaghi1, André V. Ritter2,
Carla Castiglia Gonzaga1

Marginal and internal adaptation is critical for the success of indirect restorations. New
imaging systems make it possible to evaluate these parameters with precision and non-
destructively. This study evaluated the marginal and internal adaptation of zirconia copings
fabricated with two different systems using both silicone replica and microcomputed
tomography (micro-CT) assessment methods. A metal master model, representing a
preparation for an all-ceramic full crown, was digitally scanned and polycrystalline
zirconia copings were fabricated with either Ceramill Zi (Amann-Girrbach) or inCoris Zi
(Dentslpy-Sirona), n=10. For each coping, marginal and internal gaps were evaluated by
silicone replica and micro-CT assessment methods. Four assessment points of each replica
cross-section and micro-CT image were evaluated using imaging software: marginal gap
(MG), axial wall (AW), axio-occlusal angle (AO) and mid-occlusal wall (MO). Data were
statistically analyzed by factorial ANOVA and Tukey test (α=0.05). There was no statistically
significant difference between the methods for MG and AW. For AO, there were significant
differences between methods for Amann copings, while for Dentsply-Sirona copings similar
values were observed. For MO, both methods presented statistically significant differences.
A positive correlation was observed determined by the two assessment methods for MG
values. In conclusion, the assessment method influenced the evaluation of marginal and
internal adaptation of zirconia copings. Micro-CT showed lower marginal and internal
gap values when compared to the silicone replica technique, although the difference
was not always statistically significant. Marginal gap and axial wall assessment points Key Words: marginal fit, dental
showed the lower gap values, regardless of ceramic system and assessment method used. prosthesis, zirconia, CAD/CAM.

Introduction and adequate illumination and magnification. Marginal

Marginal and internal adaptation is critical for the
success of indirect restorations (1). Margin misfit may cause
hypersensitivity, secondary caries, biofilm accumulation,
gingivitis, and periodontal problems (2-4). Marginal
misfit also results in a thick cement film, exposing the
luting material to the oral environment and promoting
its dissolution over time (5,6). It has been reported that
a 100-120-μm-thick cement layer is considered clinically
acceptable for good long-term clinical prognosis of the
indirect restoration (7,8). Poor internal adaptation can
lead to lack of restoration retention and poor resistance
form for the tooth-restoration complex (9,10). Therefore,
the study of factors that affect marginal and internal
adaptation of indirect restorations is critically important
in restorative dentistry.
Different methods have been used to assess marginal
and internal adaptation of indirect restorations. Clinically,
marginal fit can be estimated directly using a probe with
known dimensions, a dental mirror (where appropriate),
fit can also be indirectly evaluated radiographically,
and through epoxy resin replicas by light and scanning
electron microscopy (11,12). Despite being commonly
used, microscopes can result in inaccurate measurement,
poor identification of reference points, projection errors,
and rounding of the margins (13,14). It is also possible to
cross-section the prepared tooth or master die and the
restoration for direct assessment of the space correspondent
to cement gap – a surrogate measure of marginal and
internal adaptation, under a microscope (15). However, the
cross-sectioning technique has been discouraged because
it is a destructive method, it allows the assessment of only
a few reference points, and it may result in fracture or
distortion of the restoration during sectioning (13).
A popular non-destructive method used to assess the
marginal and internal fit both in vivo and in vitro is the
silicone replica technique. A light-body PVS material is used
to record the space between the prosthetic preparation and
the internal surface of the restoration (16,17), and then
 Braz Dent J 28(4) 2017 
the silicone film can be measured in multiple reference
points both at the margin and internal walls. This method
is considered easy to perform, is relatively inexpensive
(11), and is accepted as a reliable method to evaluate
marginal and internal adaptation (18); on the other hand,
the difficulty in identifying the margins of the restoration,
possible tearing of the silicone film upon removal of the
crown, as well as sectioning plane error and few reference
points are considered drawbacks of the silicone replica
technique (13,14).
Recently, microcomputed tomography (micro-CT)
imaging has also been used as a non-destructive method
to evaluate marginal and internal fit of indirect restorations
(19-21). This technique allows a two and three-dimensional
assessment of marginal and internal adaptation of
restorations in several directions and sections, making it
possible to assess a great number of reference points and
easy identification of critical distances non-destructively
(13,21).
There is no consensus on which is the best non-
destructive method to evaluate marginal and internal
adaptation of indirect restorations. Only few studies
comparing different methods for the assessment of
marginal and internal adaptation of indirect restorations
R. S. Cunali et al.
are available (14). All the studies mentioned in the review
(14) have compared the replica technique with the cross-
section technique. Only one study (22) comparing the
silicone replica technique to micro-CT was found, but
the methodology used to measure the pre-cementation
space is different from the present study. Both techniques
(micro-CT imaging and optical density image analysis)
used imaging of polyvinylsiloxane (PVS) impressions.
The authors determined the silicone thickness using a
photometric technique. Based on the Beer–Lambert Law,
proportionality between a known thickness (standardized
thickness specimens fabricated from the same impression
material) and the amount of light transmitted through the
impression material could be assumed (22).
Therefore, the objective of this study was to compare
micro-CT and silicone replica techniques for the evaluation
of marginal and internal adaptation of zirconia copings
fabricated with two different ceramic systems. The null
hypotheses were: (1) there will be no difference in marginal
and internal adaptation of zirconia copings fabricated
with different ceramic systems, and (2) there will be no
difference in marginal and internal adaptation of zirconia
copings assessed by the two methods.
Material and Methods
Two identical metal master models were used, one
for each ceramic system, representing a preparation for
an all-ceramic full crown on a lower first molar, with the
468
following characteristics: supragingival circumferential
chamfer finish line, 2.0-mm occlusal reduction, 1.5-mm
axial reduction, axial convergence angle of 6o and rounded
internal line angles.
The master models were scanned by two different
systems for fabrication of the zirconia copings (n=10):
Ceramill Map400 (Amann Girrbach AG. Koblach, Austria)
and Cerec inLab (Dentsply Sirona, York, PA, USA). Copings
0.5 mm thick at the margins and 0.8 mm at the axial and
occlusal walls were machined from zirconia blocks (Ceramill
Zi and inCoris Zi, respectively), with 20 μm-thick marginal
spacer and 70-μm-thick internal spacer. After milling,
copings were sintered. Marginal and internal adaptation
of each coping was measured using the silicone replica
technique (18,23,24) and micro-CT imaging (19,25-27).
To produce the silicone replica, each coping was
filled with a light-body PVS material (HydroXtreme light
body, Coltene Whaledent, Cuyahoga Falls, OH, USA) and
positioned on the master model. Firm finger pressure
simulating a definitive cementation procedure was applied
and after 5 min the coping was removed from the master
model. To remove the light-body material from the coping
and determine its thickness, which corresponds to the
marginal and internal gap, a regular-body PVS material
with contrasting color (HydroXtreme regular body, Coltene
Whaledent) was placed into the coping to produce the
replica. After polymerization, the replica was cut with
a sharp scalpel blade in buccolingual and mesiodistal
directions to obtain four cross-sections.
The four cross-sections of each replica were placed
on a scanner (C3180 HP Photosmart, HP) for digitization.
The high-resolution images (1200 dpi) were saved as jpg
files and a single operator determined the thickness of the
light-body PVS material using image analyzing software
(ImageJ, US National Institutes of Health, Bethesda, MA,
USA). Four assessment points of each cross section of the
replica were evaluated (Fig. 1) (23):
Marginal gap (MG): perpendicular distance at the
margin from the prepared master model to the internal
surface of the coping;
Axial wall (AW): distance at the mid-axial wall between
the internal surface of the coping and the prepared tooth;
Axial-occlusal angle (AO): distance at the region
of the axial-occlusal edge between the prepared tooth
and internal surface of the coping, represented by the
intersection of two straight lines, parallel to the axial wall
and occlusal plane;
Mid-occlusal wall (MO): distance at the center of the
occlusal region between the prepared tooth and internal
surface of the coping.
For each replica, four measurements were obtained for
each assessment point. The mean value for each assessment

point was calculated and considered for statistical analysis.
The same master models and copings were cleaned with
alcohol and then submitted to micro-CT analysis. Each
coping was adapted to the master model, placed in the
micro-CT chamber and scanned (SkyScan 1172, Skyscan,
Kontich. Belgium). For standardization purposes, micro-
CT images for the two ceramic materials were acquired
at the same time. The micro-CT has an X-ray source
with cone-beam geometry and small spot size (5 μm), in
order to reduce dispersion. An 11-megapixel camera with
CCD (charged coupled device) was used as detector. The
following scanning parameters were used: Al+Cu filter, 100
uA current, accelerating voltage of 100 kV, exposure time
of 4000 ms per frame, and rotation step at 0.4º with 180º
rotation. The X-ray was irradiated perpendicular to the long
Figure 1. Light-body silicone replica showing the four assessment
points.
Figure 2. Two-dimensional micro-CT image for measuring the
marginal and internal gap of zirconia copings. The determination of
assessment point AO is also shown, represented by the intersection
of two straight lines, parallel to occlusal plane and axial wall.
Braz Dent J 28(4) 2017
axis of the preparation and the image pixel size was 13 μm.
Volumes were reconstructed using the NRecon software
(Skyscan), employing the Feldkamp-Davis-Kress (FDK)
algorithm, beam hardening of 100%, and ring artifact
correction of 16. CTAnalyser software (Skyscan, Aartselaar)
was used to obtain cross-section images of the central
region of all copings in both buccolingual and mesiodistal
directions, and the files were saved in bmp format.
The measures for the four assessment points of the
2D micro-CT images were also performed using an image
analyzing software (ImageJ, US National Institutes of
Health). For each buccolingual and mesiodistal cross-
section images, four measurements were obtained for each
assessment point (Fig. 2). The mean value was calculated
and considered for statistical analysis.
The replica cross-sections were made visually, midway
between buccolingual and mesiodistal distances. The same
criterion was used for the selection of micro-CT images, in
an attempt to align the cross-sections and standardize the
measurements for the two assessment methods. Figures 1
Marginal and internal adaptation of crowns
and 2 show one example of the silicone replica cross-section,
indicating the four assessment points, and a 2D micro-CT
image from which the gap widths were also measured.
Figure 3 shows a representative ImageJ image illustrating
how measurements were made using the straight-line
selection tool.
For each assessment point, data were statistically
analyzed using factorial ANOVA (ceramic system and
assessment technique) and Tukey test with α=0.05.
Correlation between marginal and internal gap values
determined by micro-CT and replica technique was
performed using coefficient of determination (R2) and
Pearson’s coefficient. All the analyses were performed
with statistical software (Statistica 10; StatSoft Inc.,
Figure 3. Representative ImageJ image illustrating how measurements
(MO in this example) were made with the straight-line selection tool.
This tool was used to create the line selection at each assessment point.
In the dialog box at the bottom left side of the image, the length (in
μm) is displayed in the last column.
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 Braz Dent J 28(4) 2017 

Tulsa, OK, USA). micro-CT techniques presented significant statistically

Results
For MG and AW, ceramic system, assessment technique
and double interaction were not significant (p>0.05).
However, assessment technique was statically significant
for MO and AO (p=0.000825 and p=0.000044, respectively).
Ceramic system and double interaction were also not
significant (p>0.05).
Means and standard deviations for the assessment
points evaluated by micro-CT and replica technique of the
zirconia copings are shown in Table 1. For both ceramic
systems, there was no statistically significant difference
between the two techniques for MG and AW. On the other
hand, for AO, there were significant differences between
techniques for Amann copings, while for Dentsply Sirona
copings similar values were observed. For MO, replica and
R. S. Cunali et al.
differences for both ceramic systems.
For both ceramic systems, a strong positive correlation
between the marginal and internal gap values determined
by silicone replica and micro-CT assessment methods was
observed (Fig. 4) (R2 correlation coefficient of 0.97432 and
0.86219 for Amann and Dentsply Sirona, respectively; and
Pearson correlation coefficient of 0.98708 and 0.92854 for
Amann and Dentsply Sirona, respectively).
Discussion
Marginal and internal adaptation is one of the most
important factors for the success and clinical longevity of
ceramic crowns. This study compared two non-destructive
assessment methods to evaluate marginal and internal
adaptation of zirconia copings fabricated with two CAD/

Figure 4. Correlation plot between marginal and internal gap values determined by micro-CT and replica techniques.

Table 1. Means and standard deviation for marginal and internal fit (μm) evaluated by micro-CT and replica technique for the two ceramic systems

Points
Ceramic system Assessment method
Marginal gap Axial wall Axial-occlusal angle Mid-occlusal wall
Replica 77.90±12.21 a 83.63±14.43 a 162.65±39.88 b 187.35±53.89 b
Amann
Micro-CT 68.73±8.86 a 81.00±15.84 a 110.83±14.08 a 126.53±18.12 a

Replica 77.83±16.13 a 84.23±17.37 a 138.65±34.48 ab 179.70±48.97 b

Dentsply Sirona
Micro-CT 74.83±6.84 a 85.53±7.09 a 121.88±14.18 a 121.53±16.43 a

In each column, values followed by same letter are statistically similar (p>0.05).
470

CAM systems. According to the results, the first test
hypothesis was accepted, i.e., there was no difference
in marginal and internal adaptation of zirconia copings
fabricated with different ceramic systems, was accepted,
while the second test hypothesis was rejected, i.e, there
was a difference in marginal and internal adaptation of
zirconia copings evaluated by the two methods. In the
present study lower values of marginal and internal gap
were observed for micro-CT in comparison to the replica
technique for the two ceramic systems tested.
Recently, micro-CT has been widely applied in dentistry,
and is commonly used for implant planning, evaluation
of root canal preparation, forensic investigations and
marginal adaptation of ceramic crowns. It is a non-
destructive method of analysis that allows the evaluation
of marginal and internal fit of indirect restorations
through high-resolution images, permitting 2D and 3D
visualization from any angle or position. By this technique,
marginal and internal adaptation can be evaluated on x
and y axes, enabling a more realistic perception of the
space correspondent to the cement. However, in some
situations, especially when there is insufficient radiographic
contrast between the materials, marginal and internal gap
analysis cannot be performed (19,20). Thus, to improve
the contrast between metal master model and zirconia
coping, in this study micro-CT scanning was performed
without cementation. In previous studies, the radiopacity
of the resin cement may have interfered with the results
(20). Also, cementation was not performed because all
copings were adapted onto the same two master models
for scanning, one for each ceramic system. If the copings
were cemented for scanning, each coping would have
to be removed and a new one cemented onto the same
master model. This procedure could have caused damage
to the master model and interfered with the results of
gap measurements in subsequent samples. Other studies
have also used this methodology and did not perform
cementation of indirect restorations submitted to micro-CT
analysis (19,20). Nevertheless, other studies have shown
that when there is no cementation some factors related
to the cementation process and type of cement cannot
be considered (21).
The CAD/CAM systems used to fabricate the zirconia
copings in the present study were unable to create a
homogeneous cementation gap, even though a 20 μm
marginal spacer thickness and a 70 μm internal spacer
thickness were previously established. Indirect restorations
with homogeneous cementation gaps are important so
that retention and resistance forms are not compromised,
especially for ceramic restorations, due to their fragility.
Some studies have already evaluated the impact of different
spacer thickness settings (or luting space settings) on
Braz Dent J 28(4) 2017
marginal and internal fit of ceramic restorations (28,29).
The results of these studies indicated that luting space
settings might influence the marginal fit. Programming
a small spacer thickness may result in premature contact
points between the prepared tooth and the internal surface
of the crown (20,29), preventing the overflow of excess
cement and increasing marginal gap (28).
Different gap widths depending on the location
(assessment point) may be related to the quality of the
acquisition and processing of the CAD/CAM technology
(15). Increase on the internal gap may result in rounded
edges produced by the finite resolution of the scan of CAD/
CAM systems. Furthermore, the overshoot phenomenon,
which simulates virtual peaks near the edges, can also be
responsible for higher values of internal gap (19).
In the present study, mean values for marginal gap
varied from 68.73 to 77.90 μm, with no statistically
significant difference between ceramic systems and
assessment methods. All values were lower than 120 μm,
considered the clinically acceptable limit for marginal gap
Marginal and internal adaptation of crowns
(7,8). Literature reports that on the axial walls of prepared
tooth, gap values around 122 μm could reduce fracture
resistance of crowns (10). Considering this information as
well as the fact that, in this study, mean gap values for
axial walls ranged from 81.00 to 85.53 μm, the evaluated
ceramic systems can be considered suitable for clinical
use. Axio-occlusal angle and mid-occlusal area presented
the higher gap values, respectively 110.83-162.65 μm and
121.53-187.35 μm. In fact, from the clinical perspective,
of all assessment points, marginal adaptation should be
considered the most critical to evaluate.
Another study (20) evaluated the internal and marginal
fit of lithium disilicate crowns fabricated using heat-press
technique and CAD/CAM with different spacer thickness
(30, 60 and 90 µm). Results showed that marginal fit values
for CAD/CAM-60 µm group (49.35 µm) and for CAD/CAM-
90 µm group (46.65 µm) were lower than those observed
for CAD/CAM-30 µm group (55.18 µm). However, it is
important to observe that all those values are low and
clinically acceptable for marginal gap of ceramic crowns.
On the other hand, it is interesting to note that for the axial
and occlusal wall reference points, even when the spacer
thickness was predetermined, the gap width obtained was
higher. For example, for axial and occlusal walls respectively,
the group with a 30 µm spacer thickness presented gap
values of 90.04 and 160.49 µm; the 60 µm spacer group
presented values of 127.68 and 152.39 µm; and 90 µm
spacer group showed 147.71 and 227.38 µm. Therefore,
spacer thicknesses of 30 or 60 µm were recommended for
crowns fabricated using CAD/CAM technology.
The same phenomenon can be observed, in a smaller
scale, in the results of the present study, when spacer
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 Braz Dent J 28(4) 2017 
thicknesses of 20 µm and 70 µm were predetermined,
respectively, for the margins and for the internal axial
and occlusal walls. In a previous study (20), gap widths
obtained for the 60 µm-spacer group for axial and occlusal
walls were approximately 113 and 152% higher than the
programmed spacer thickness. The present study used a
preset internal spacer thickness of 70 µm, but gap values
were from 22 to 73% higher than the predetermined value
for axial and occlusal walls, respectively.
The two evaluated ceramic systems showed similar
values for marginal and internal fit. This result was
expected, since the processing method of the copings
from both systems is similar. It is important to observe
that zirconia copings were machined in larger dimensions
to compensate for sintering contraction, and this may
have also influenced the gap values. The success of
this compensation depends on the homogeneity of the
pre-sintered block and on the software’s capability of
estimating the real contraction of the material (16). Thus,
both systems were able to compensate the zirconia sintering
contraction providing clinically acceptable results. Different
results can be expected for multiple fixed prostheses, since
other difficulties and distortions on impressions and casts
may occur, as well as problems with ceramic sintering
R. S. Cunali et al.
contraction compensation.
Although both methods are proposed to assess the
marginal and internal fit of indirect restorations by
measuring the cement thickness through image analysis
software, the light-body silicone might have impaired the
correct adaptation of the coping onto the model or tooth,
and the polymerization of the silicone could also have
influenced the measurement of the cement thickness, which
resulted in significant differences between cross-sections
of silicone replica and of micro-CT images.
There is still no standard protocol to evaluate the fit
of indirect restorations. This lack of standardization may
compromise interpretation and comparison of data from
different studies and to provide guidelines for clinical
practice. Thus, it is important to recognize the limitations
of the currently used techniques, as well as the kind of
data that may obtained with each method (16). Few studies
compared different methods used to evaluate marginal and
internal fit of ceramic restorations (14), and only one study
used silicone replica technique and micro-CT (22). However,
it is important to note that the methodology presented in
this previous study (22) is different from the one used in
the present study. Rungruanganunt et al. (22) evaluated
the pre-cementation space of single zirconia copings
using two methods: micro-CT and quantitative optical
analysis. Impressions of the pre-cementation space were
taken with low viscosity PVS and standardized thickness
specimens were also fabricated from the same impression
472
material. Micro-CT images were then obtained from the
silicone specimens and standards. The quantitative optical
analysis method used the same standardized thickness
specimens and measured the cement space thickness by
transilluminating the pre-cementation space impressions.
Also, the results from the present study cannot be directly
compared to a previous study (22), because there are
significant methodological differences and the values for
marginal and internal adaptation are not reported and
analyzed in the same way. The distribution of thicknesses
in the pre-cementation space replica measured by micro-CT
was reported by volume percentage and more than 90% of
the measurements ranged from less than 50 µm to 170 µm.
The present study compared two increasingly used
methods for the evaluation of marginal and internal fit
of prosthetic restorations. Several studies and literature
reviews suggested that micro-CT could be recommended as
a useful tool for evaluating the adaptation of all-ceramic
restorations (13,19,21). Based on the results of the present
study, the authors corroborate this recommendation. Also,
the results suggest a strong positive correlation between the
marginal and internal gap values determined by micro-CT
and replica technique (Fig. 3). Therefore, both techniques
can be used to determine the fit of indirect restorations.
Finally, it should be noted that long-term clinical studies
should be carried out in an attempt to update what would
be the clinically acceptable limit in terms of marginal
and internal fit all-ceramic prosthetic restorations. The
parameters still considered as references in the literature,
and also for this work, are based on studies published in the
1970-1990 (7,8). However, when they are established, most
current ceramic systems and techniques for the fabrication
of indirect restorations were not yet available. Furthermore,
the selection of the ceramic system to be used should be
based not only on the values of marginal and internal fit,
but also on the system’s ability to produce a restoration
that fulfills the existent clinical conditions as well as the
aesthetic expectations of the patient (13).
Based on the results of the present study, the following
conclusions could be drawn: i) the two ceramic systems
evaluated presented similar gap values. All marginal and
internal gap values obtained were considered clinically
acceptable; and ii) micro-CT showed lower marginal and
internal gap values when compared to silicone replica
technique. Marginal gap and axial wall assessment points
showed the lowest gap values, regardless of ceramic system
and assessment method used.
Resumo
A adaptação marginal e interna é fundamental para o sucesso das
restaurações indiretas e novos sistemas de imagem permitem avaliar
esses parâmetros de maneira não-destrutiva e com precisão. Este estudo

avaliou a adaptação marginal e interna de copings de zircônia fabricados
com dois sistemas diferentes, utilizando as técnicas da réplica em silicone
e micro-CT. Um modelo-mestre de metal, representando um preparo para
uma coroa totalmente cerâmica foi digitalizado e copings de zirconia
policristalina (Ceramill Zi, Amann Girrbach e inCoris Zi, Dentslpy Sirona,
n=10) foram fabricados. Para cada coping, a adaptação marginal e interna
foi avaliada pelas técnicas da réplica em silicone e micro-CT. Foram
avaliados quatro pontos de cada seção transversal e imagem de micro-CT:
adaptação marginal (MG), parede axial (AW), ângulo axial-oclusal (AO) e
parede centro-oclusal (MO) utilizando um software de imagem. Os dados
foram analisados estatisticamente por ANOVA e teste de Tukey (α=0,05).
Não houve diferença estatisticamente significativa entre as duas técnicas
para MG e AW. Para AO, houve diferenças significativas entre as técnicas
para copings da Amann, enquanto que para copings da Dentsply Sirona
foram observados valores semelhantes. Para o MO, ambas as técnicas
apresentaram diferenças estatisticamente significativas. Observou-se uma
correlação positiva entre os valores de adaptação determinados pelas duas
técnicas. O método de avaliação influenciou a avaliação da adaptação
marginal e interna de copings de zircônia. Pode-se concluir que a micro-
CT mostrou menores valores de adaptação marginal e interna quando
comparado com a técnica de réplica em silicone. Os pontos de avaliação
da margem e da parede axial mostraram os menores valores de adaptação,
independente do sistema cerâmico e da técnica de avaliação utilizados.
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Received February 13, 2017
Accepted May 15, 2017
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